冠動脈栓塞に起因する急性心筋梗塞の流行,臨床的特徴,および予後
Tatsuhiro Shibata1, Shoji Kawakami1, Teruo Noguchi2
1From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan.
Circulation
|July 29, 2015
まとめ
冠動脈栓塞 (CE) は,急性心筋梗塞患者の約3%に影響し,しばしば心房細動によって引き起こされます. これらの患者は,心疾患による死亡と有害事象のリスクが著しく高く, 厳密なモニタリングが必要である.
科学分野:
- 心臓病科
- 血管医学
- トロンボシス
背景:
- 冠動脈栓塞 (CE) は急性心筋梗塞 (AMI) の認識されていない原因です.
- CEの流行,臨床プロファイル,および長期的なアウトカムに関するデータは限られている.
- CEを理解することは,非動脈硬化性AMIの管理に不可欠です.
研究 の 目的:
- 新発性AMI患者におけるCEの罹患率と臨床的特徴を決定する.
- 治療戦略,入院の結果,CEの長期的な予後を評価する.
- CE患者とマッチングされた非CE AMIコホート間のアウトカムを比較する.
主な方法:
- 連続したde novoAMI患者1776人をスクリーニングした (2001年−2013年).
- 組織学,血管学,イメージング基準を用いてCEを診断した.
- 平均49ヶ月の追跡期間中の結果の比較のために利用された傾向スコアマッチング.
主要な成果:
- CEの罹患率は2. 9% (52人の患者) で,心房細動が最も一般的な原因であった (73%).
- 抗凝固剤の治療不足が認められ,CHA2DS2- VAScを用いたリスクの階層化は,より高いリスクの患者を特定した.
- 心臓発作患者の心臓死亡率は著しく高かった (HR 9. 29),そして5年間の主要な有害事象の発生率は27. 1%であった.
結論:
- 心房細動は冠動脈栓塞の 主な原因です
- CE患者は,急性心筋梗塞の集団の中で高リスク群を構成しています.
- 強化されたフォローアップと最適化された抗凝固戦略は,CE患者にとって不可欠です.
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